Dysphagia is a swallowing disorder, wherein a person is unable to swallow or has difficulty swallowing. Dysphagia often runs concurrent to many acquired and chronic medical conditions and is known to affect both adults and children. Some of these medical conditions include stroke, Parkinson disease, cerebral palsy, or respiratory disorders. Left untreated, dysphagia can cause health complications such as aspiration, malnutrition, dehydration, asphyxia, recurrent respiratory infections and death.
Dysphagia is diagnosed by clinical professionals, typically speech-language pathologists, who are educated in anatomy and physiology of the oral and pharyngeal mechanisms responsible for deglutition. Diagnosis of dysphagia is typically determined through a clinical evaluation which may or may not include use of technology such as a videofluroscopic swallow study (VFSS). A VFSS is generally conducted in a radiology suite by a speech-language pathologist in conjunction with a radiologist. The purpose of the swallowing evaluation is to determine if there is dysfunction in the swallowing mechanism and the type and severity of the dysfunction. Once the diagnosis of dysphagia is made and the type and severity is determined, treatment to remediate and/or compensate for the disorder is initiated.
Medical professionals generally treat dysphagia patients by modifying the consistency of foods and liquids consumed by dysphagia patients. Diet modification typically is the most common used compensatory strategy to manage dysphagia patients. Foods are routinely altered by adding a commercial thickener, and foods are generally thinned by adding water or other thin liquid. Some examples of commercial thickeners include cornstarch and baby cereal. Currently, foods for dysphagia patients are generally thinned or thickened to fall within one of a group of pre-established diet-type categories to quantify the thickness of the liquids, such as honey thickness, nectar thickness and thin liquids. The exact characteristics for each of these or other pre-established dysphagia diets are undefined and not standardized. Dysphagia patients are typically placed within one of these diet categories, even though that particular diet category may not precisely meet the needs of that patient.
Moreover, the current process for determining the thickness of liquids and foods for each of the dysphagia diet categories is based on individual judgment. The conventional method is problematic due to the inherent inconsistencies and ambiguousness of the dysphagia diets. A dysphagia diet typically requires all liquids and foods eaten by the patient to be altered in consistency by blending and/or thickening. In such a procedure, there is no set, uniform measurement to determine the thickness or consistency of the liquids and foods prescribed to the dysphagia patient. Presently, therapists typically pour foods or liquids into a container, add water or a commercial thickener, and stir the mixture until the mixture appears to be the proper consistency. More water or thickener is added until the therapist visually estimates whether the consistency is appropriate, using their best clinical guess.
A therapist may also pour the mixture from a spoon to visually determine the consistency. The mixture is then classified into one of predetermined groups, such as (1) “honey” thickness, (2) “nectar” thickness or (3) “thin,” depending on what consistency it most resembles. If a dysphagia diet is prescribed and a liquid consistency is deemed appropriate for the patient, the patient is instructed to drink only one of the predetermined classifications of consistency prescribed, and no other consistency, because other consistencies could be aspirated (take liquids into their lungs). Aspiration can have serious and deadly consequences to a patient's health, such as causing pneumonia, weight loss, fevers, recurrent respiratory illness, or even death. Unfortunately, without a consistent, standardized measurement system, the perception of “honey,” “nectar” and “thin” liquids is so variable between people that they are rarely the same. Even the same therapist can mix two separate batches of liquids and foods and have resulting variations in the consistency. For a patient, such variations can be deadly.
Further adding to the problem, dysphagia patients are routinely transferred between medical facilities in clinical care. As a dysphagia patent's condition improves, the dysphagic patient may often move from acute care to subacute care, then to a rehabilitation facility, then to a long-term care facility, and then perhaps to their home. The potential for problems, in terms of quality of care that the patient receives, increases with each transfer between treatment locations because of variability between caregivers in the preparation of food consistencies. A specific technical problem is the inability for a patient or their caregiver to replicate the food consistency with that patient's prescribed dysphagia diet.
Current and common methods of treatment include: 1) providing patients with written descriptive diet plans containing examples of recommended foods and liquids, or 2) recommending purchase of a particular commercially prepared product based on its viscosity. Neither of these current treatment methods is optimal. Written descriptive diets require the preparer of the dysphagia diet food and/or liquids to estimate the appropriate consistency or viscosity by visually comparing it to another similar food item.
On the other hand, manufacturers use different techniques and machinery which are not consistent with each others manufacturing methods. Consequently, manufacturers of dysphagia food products have different standards of consistency and viscosity. Therefore, the patient may inadvertently consume an inappropriate consistency if they use products from different manufacturers, placing themselves at risk for aspiration or other health consequences.
While the exact number of people suffering from dysphagia is unknown, the occurrence of dysphagia in older people is significant, especially people who have suffered an acute, first-time stroke. The U.S. Census Bureau estimates that 16,500,000 people will require care for dysphagia by the year 2010.
Viscometers are available for commercial and clinical use, but these devices are not designed for a patient and/or caregiver to use independently at home. Presently, there is no technique, procedure or method for clinical professionals, caregivers or patients to independently determine acceptable prescribed foods and liquids based on objective determinations.
Accordingly, there is a strong need for a quantitative measurement system that can easily measure food characteristics for dysphagia patients, enabling foods to be reproduced having consistent properties, regardless of the manufacturer, cook, or therapist preparing the food. There also is a need for customized dysphagia diets that more precisely meet the specific needs of each dysphagia patient.